Do masks scare COVID?

he time has come for me wade into the coronavirus mask controversy with a minority viewpoint. The American Centers for Disease Control (CDC) now suggests that anyone deciding to venture out into the world wear a face covering of some kind. This has been standard in Italy for nearly two months. But there’s no one standard. New York City health officials want people to be masked in situations where social distancing “would be impossible.” As of April 22, California decided to refuse admission to store customers without one. The idea is not that a mask will protected the healthy, but that people who are infected without knowing it are less likely to infect others if they’re wearing a mask.

The rationale is that some (not all) of the countries that managed to keep the pandemic under control put masks on its population — and so the mask defense was born.

Masks failed to decrease the amount of coronavirus that arrived on a petri dish 20 centimeters away.

Masks do seem to help against influenza. Several studies using machines to generate breath particles concluded masks were effective in containing the spread of flu. At the same time, until recently the CDC urged people not to wear surgical masks for fear of depleting the supply available to health care workers. In a backhanded way, this suggested the CDC and others actually believed they worked as a means of prevention.

As a doctor, I used to think masks might be somewhat helpful to keep the sick from spreading diseases. What changed my mind was tracking down the only study in which actual COVID-19 patients were asked to don masks and systematically cough out infected material. Neither surgical masks nor cloth masks substantially decreased the amount of coronavirus that arrived on a petri dish located 20 centimeters away. Game, set, match.

Incidentally, whatever kind of mask was used, significantly more of the live virus was found on the outside surface of the mask than on the inside. These researchers did not test the more advanced N95 (FFP2 or FFP3) respirator masks, the ones worn by hospital employees. These are thought to protect the wearer. They’re also costly.

Being an open-minded scientific sort, let me mention a study that does not support my proposition about masks. That study analyzed data collected five years ago in Hong Kong, a city that has had to deal with its fair share of viral contamination. The researchers found surgical masks had some blocking effect against viruses, including corona viruses that were causing common cold symptoms. Their methodology isn’t entirely clear. Apparently they somehow collected air exhaled by sick patients while they breathed, and coughed, over a 30 minute period. For me, this is not very relevant when it comes to knowing if masks will keep asymptomatic COVID-19 patients from infecting those around them, whether on streets or in stores.

Masks failed to decrease the amount of coronavirus that arrived on a petri dish 20 centimeters away.

At last call the World Health Organization had weighed in on my side. Masks are of no great help if you’re trying to remain uninfected.

Some are convinced mask-wearing is of psychological value (making people feel more secure) and will encourage healthier and more medically attentive behavior in the months and years to come. I think the exact opposite: masks will bring a false sense of security, making people less likely to practice proper social distancing, which for me is a key component of any strategy going forward.

Take AIDS. Many gay men reverted to unprotected anal sex as soon as soon as the first (and very mediocre) HIV treatments came out. This only worsened the situation.

When one California store forced me to wear a mask, even I felt safer – despite knowing better than anybody that it was giving me no protection whatever. While we await further research to settle the question, consider this excerpt from a recent “New York Times” piece on the virus: “‘This is just the next step,’ said a retired corrections officer, Stanley Woo, 63, sitting down to play chess in a park in Forest Hills, Queens, with his old friends and his new mask.”

It is no longer the same old world, and many people are getting used to that.

New York native Susan Levenstein, MD, moved to Italy in 1978 and has maintained a successful Rome primary care practice since 1980. She has a professional website and writes a blog. In May 2019, Paul Dry Books published her memoirs, entitled "Dottoressa".

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